What is HPPD (Hallucinogen(ic) Persisting Perception Disorder)?
Table of Contents
- What is HPPD (Hallucinogen(ic) Persisting Perception Disorder)?
- The Origins of HPPD
- How Does HPPD Occur?
- Myths and Misunderstandings of HPPD
- Substances Known to Cause HPPD
- Other Hallucinogenic Substances and HPPD
- Is HPPD Common?
- Telltale Signs of Hallucinogen Persisting Perception Disorder
- What Hallucinogens Can Trigger HPPD?
- Examples of HPPD from Shared Experiences
- HPPD and Dual Diagnosis
- How is HPPD Diagnosed?
- Forms of Treatment for HPPD
- Coping Mechanisms for Hallucinogen Persisting Perception Disorder
- Seeking Treatment for HPPD
- Medically Reviewed By
Hallucinogen Persisting Perception Disorder (HPPD), also known as acute hallucinogen induced psychosis, is a non-psychotic disorder, in which an individual has lasting or persistent visual hallucinations or perceptual distortions after having previously experienced an illusory episode while using a hallucinogen drug. These are typically referred to as ‘flashbacks.’
This experience is further characterized by these symptoms occurring despite a lack of alcoholic or drug-based influence as their cause, and the individual’s awareness that their symptoms are a result of drug usage.
While this condition usually resolves itself within a few weeks to several months, some cases can be far more severe (particularly for individuals who struggle with abusing hallucinogenic drugs), lasting for several years or even becoming a life-long disorder.
The Origins of HPPD
Because Hallucinogen Persisting Perception Disorder is such a rare disorder, it can be a difficult one to understand. Many of the individuals diagnosed with HPPD, will likely have had a history of previous psychological or substance abuse issues.
However, this condition can affect anyone, even those experimenting with drugs known to trigger hallucinations for the first time.
How Does HPPD Occur?
Unfortunately, researchers and doctors have yet to find a definitive cause for HPPD, nor defining characteristics that increase a person’s likelihood of developing this disorder.
There are, however, factors that are known not to be the cause of HPPD, which can help in the diagnosis process by eliminating other potential causes for an individual’s symptoms. These include:
- Brain Injury
- Neurological disorders (i.e. epilepsy or seizures)
- Other psychiatric conditions
Myths and Misunderstandings of HPPD
It is common to associate HPPD with being the result of a ‘bad trip.’ However, while it is possible for an individual to develop Hallucinogen Persisting Perception Disorder after experiencing a bad trip, not every person diagnosed with this disorder has had one.
Furthermore, HPPD is not the result of a drug having been stored by the body, only to be released at a later time. This is a very popular myth, but not at all a causing factor.
Hallucinogen Persisting Perception Disorder is also not a result of being under the influence of a substance; many people with this disorder begin experiencing symptoms days, weeks, and even months after drugs.
Substances Known to Cause HPPD
Hallucinogen persisting perception disorder is most commonly associated with individuals who use or abuse hallucinogenic drugs such as LSD, MDMA (ecstasy), psilocybin (magic mushrooms), DMT, etc., with LSD being the most commonly reported cause of HPPD.
LSD (lysergic acid diethylamide) is a psychedelic drug that, when taken in small doses, can cause mild changes in an individual’s perceptions, mood, and thoughts. When taken in larger quantities, this drug may cause visual hallucinations and distortions of space and time.
If a person is diagnosed with hallucinogen persisting perception disorder after using LSD, this may be referred to as post LSD visual disorder.
Loss of Reality After Tripping
It is not uncommon for people to experience what is referred to as an ‘ego dissolution’ or ‘ego death,’ in which they may feel as though the boundary separating their individual self from the world around them is dissolved.
This may be a positive and enlightening experience for some while causing extreme panic and anxiety in others. This experience may be considered a ‘bad trip,’ due to the negative feelings associated with this loss of reality.
Side Effects of MDMA (Ecstasy)
MDMA is a synthetic drug that can cause the individual consuming it to experience altered states of mood and perception, usually regarding their awareness of their surrounding objects and conditions.
For those who take this drug, increased energy levels, sensory stimulation, pleasure, and perceptual distortions of time.
Side Effects of Psilocybin
Psilocybin, or magic mushrooms, can have a multitude of side effects during its usage, including both mental and physical adverse reactions. Although remote, the possibility of overdose on ‘shrooms exists and is something to educate yourself regarding if you take this substance.
Physical Side Effects
Some of the most common physical reactions to taking psilocybin include:
- Dilated pupils
- Poor coordination
- Increased temperature, blood pressure, and heart rate
Mental Side Effects
Some of the most common mental reactions to taking psilocybin include:
- Visual and/or auditory hallucinations
- Introspective and/or spiritual experiences
- Distortion in sense of time, place, and/or reality
- Increased panic and paranoia
The Side Effects of DMT
DMT (N, N-dimethyltryptamine) is a hallucinogenic tryptamine drug that produces similar effects to LSD and psilocybin. Individuals who use DMT may report having ‘out-of-body’ feelings, as well as experiencing strange and/or overwhelming visual illusions (i.e. bright lights, strange shapes), and, like LSD, distortions in time and space.
Other Hallucinogenic Substances and HPPD
Aside from the aforementioned drugs, other substances, such as Salvia, can produce similar (though usually not as long-lasting) hallucinogenic effects.
Side Effects of Salvia
Salvia’s main active ingredient, salvinorin A., changes the way the brain works, affecting the signaling process between neurons, and thus disrupting communication between the brain’s nerve cells.
This interaction, while usually only lasting around 30 minutes, can cause vivid and overwhelming hallucinations for those who use this substance.
Can Salvia Cause Hallucinogen Persisting Perception Disorder?
While there is very limited research directly linking Salvia to the development of a persisting perception disorder, it may be helpful to understand the similar ways in which they behave to drugs such as LSD.
Is HPPD Common?
Hallucinogen persisting perception disorder is considered to be a somewhat rare occurrence, occurring in an estimated 4.0% to 4.5% of people with histories of hallucinogen use.
The most common mental disorders (or otherwise) associated with hallucinogenic drug use are panic disorders, alcohol use disorders, depersonalization disorder, and major depressive disorder.
Telltale Signs of Hallucinogen Persisting Perception Disorder
Hallucinogen persisting perception disorder is most commonly associated with changes or irregularities in the way an individual perceives visual input. HPPD can present itself in two different ways:
- Type 1. The individual experiences brief and random flashbacks.
- Type 2. The individual experiences persistent visual hallucinations or changes to their vision, which can come or go at random.
Furthermore, there are several different types of visual disturbances an individual with HPPD may experience, including:
- Seeing auras or rings of light around objects.
- Colors look more vivid or intense than usual.
- Color confusion or swapping; not being able to differentiate between colors.
- Tracers or trailers; outlines of an object or image may trail through the visual field.
- Seeing geometric patterns or shapes in objects that aren’t really there.
- Seeing images within images.
- Trouble with reading; words on a page or screen may appear to be shaking, or are jumbled together.
- Objects may appear to be vibrating or moving even if they are completely still.
- Visual snow; air looks grainy or textured either throughout entire or peripheral visual fields.
- Feelings of unease, due to being aware that symptoms are unusual; can lead to feelings of embarrassment or isolation.
Also known as visual static, visual snow is an uncommon neurological disorder characterized by seeing white, black, transparent, or multicolored dots, either in partial areas or the entirety of their visual field. Traits of visual snow often include visual disturbances such as:
- Air appears to have a grainy texture
- Increased afterimages
- Imagery and/or color trails
One of the most significant symptoms of Hallucinogen Persisting Perception Disorder is flashbacks, which are characterized by the feeling that an individual is reliving a past experience. While these can occur due to drug usage, other reasons, such as post-traumatic stress disorder (PTSD) can also cause them.
Both PTSD and pleasurable drug-induced flashbacks involve an individual’s senses causing them to feel as though they are completely immersed in this past occurrence or ‘trip’, even if they are not.
For those struggling with HPPD, these flashbacks consist of disruptions to their visual fields, but the individual is aware they are not really reliving this experience. As the flashbacks become more frequent and disruptive in nature, this disorder can become debilitating.
What Hallucinogens Can Trigger HPPD?
While individuals with a history of hallucinogenic drug use are more likely to receive a diagnosis for hallucinogen persisting perception disorder, it is not limited to extended drug usage. Even an individual experimenting with a hallucinogen substance for the first time can develop a form of Hallucinogen Persisting Perception Disorder.
While there are multiple hallucinogenic drugs associated with causing HPPD, it is most commonly reported as occurring after the use of LSD.
It is important to keep in mind that, while using hallucinogenic drugs can be enjoyable in the moment, they pose the risk of multiple adverse effects aside from developing HPPD, and can even be lethal depending on the amount taken, and their interaction with any underlying health conditions.
Despite hallucinogen persisting perception disorder being a relatively rare condition, there are several case studies documenting individuals struggling with Hallucinogen Persisting Perception Disorder and their personal experiences.
Case Study Involving LSD and Anxiety-Enhanced Symptoms
In the case of a 21-year-old man diagnosed with acute hallucinogen-induced psychosis, it was discovered that he was suffering from HPPD after being admitted to the behavioral health unit at his local hospital.
After having a severe reaction to LSD almost seven months prior, the patient began struggling with repeatedly experiencing flashbacks of the trip. In this patient’s case, he reported experiencing difficulties with concentrating, sleeping, and feeling isolated, having struggled to find a support system.
Because of his symptoms, the patient was unwilling to return to his job as a lumberjack (due to concern for the safety of himself and others). The patient claimed that, due to his difficulty in finding another job, he was at risk of being kicked out of his home, and his anxiety had been higher than normal. Increased levels of anxiety and stress can severely exacerbate HPPD symptoms, as seen in the severity and frequency of this patient’s symptoms.
Fortunately, under observation in the behavioral health unit, the patient made a full recovery after being administered Clonazepam 1 mg four times a day.
Case Study Involving Mixed Drug Usage
In the case of a 33-year-old woman who had been struggling with hallucinogen persistent processing disorder for almost thirteen years, her drug usage occurred at the age of 18 during a 1-year trip to the United States.
The patient reported having taken up to 30 doses of LSD throughout her stay, as well as experimented with marijuana, ecstasy, psilocybin mushrooms, and ketamine. Upon returning to Europe, she began experiencing flashbacks of trips, as well as seeing after images, perceiving motion in the periphery of her visual fields, flickering when looking at patterned objects, halo effects, macro- and micropsia, and perceiving bright little spots of light across her visual field.
Over the course of this thirteen-year-long struggle, the patient tried numerous treatment options, none of which were successful in treating her symptoms. This eventually led to the patient’s developing of depression and suicidal thoughts, which only further worsened her symptoms.
Finally, after undergoing a clinical trial in which the patient was administered controlled amounts of antiepileptic lamotrigine (200 mg daily maximum, reduced to 100 mg daily), some of her symptoms (macro-/micropsia) stopped completely, while others decreased in frequency and intensity.
The patient also reported that psychotherapeutic intervention significantly decreased difficulties experienced with attention-focusing and mood-stabilizing.
HPPD and Dual Diagnosis
For individuals struggling with hallucinogen persisting perception disorder, it is not uncommon for them to have additional mental disorders or a ‘dual diagnosis.’
The most commonly associated mental disorders and/or substance abuse disorders associated with hallucinogenic drug use include panic disorder, alcohol use disorder, depersonalization disorder, anxiety disorder, and major depressive disorder.
Panic disorder is a type of anxiety disorder that is distinguished by random and repeated instances in which feelings of intense fear arise in an individual. Other symptoms may include:
- Chest pain
- Heart palpitations
- Shortness of breath
- Abdominal distress
Alcohol Use Disorder
For individuals who attempt to self-medicate through the use of alcohol, addictive habits that characterize an alcohol use disorder can develop over time.
Those struggling with an alcohol addiction may find themselves experiencing symptoms such as:
- An inability to quit drinking (even if the alcoholism is causing other issues).
- Withdrawal effects from stopping alcohol intake.
- The emotional and physical dependence on alcohol.
Depersonalization disorder is commonly associated with symptoms such as:
- Feeling disconnected from one’s body.
- Feeling as though life is being observed, rather than lived by the individual.
- Feeling as though the world is foggy, or detached and distant from the individual.
Individuals suffering from an anxiety disorder may find themselves experiencing stress or discomfort that is unproportional to the triggering event, and an inability to relax or stop worrying. Other symptoms include:
- Hypervigilance and irritability
- Trouble concentrating and increased intrusive thoughts
- Fatigue, sweating, trembling, heart palpitations, nausea
- Insomnia and/or troubled sleeping patterns
Major Depressive Disorder
This disorder is characterized by a consistently depressed mood and loss of interest in everyday activities and/or responsibilities, which can be incredibly debilitating for those struggling with this condition. Other symptoms include:
- Hopelessness, discontentment, feelings of guilt, loss of interest, mood swings, detachment
- Increased agitation, excessive crying, social isolation, irritability
- Insomnia, excess sleepiness, trouble falling and/or staying asleep
- Increased hunger, loss of appetite, fatigue
- Difficulty concentrating, lethargy, suicidal thoughts
- Obsessive-compulsive behaviors such as overthinking, binge-eating, skin-picking, etc.
How is HPPD Diagnosed?
For individuals with frequent abnormal visual experiences or persistent visual hallucinations, seeking out a medical diagnosis for hallucinogen persistent processing disorder may be beneficial.
It is important for individuals struggling with substance abuse to be open and honest with their doctors about their drug/alcohol use, as this helps to rule out any other possible causes for their symptoms.
When it comes to diagnosing Hallucinogen Persisting Perception Disorder, it may be beneficial to receive multiple medical opinions. Because it is such a rare condition, some doctors may not be as informed on its causes and symptoms and therefore may fail to consider it as a possible reason for the patient’s persistent visual disturbances.
Forms of Treatment for HPPD
While researchers have yet to produce a specific course of treatment for those struggling with hallucinogen persistent processing disorder, there are two medications that have been found effective in treating some symptoms:
- This is a mood-stabilizing and antiepileptic medication that has been used in studies on HPPD treatment. When used over a 12-month period, test subjects reported that several of their complex visual disturbances receded.
- During a 2015 case study, administering controlled levels of Clonazepam proved effective in treating (and even completely eliminating) perceptual symptoms associated with HPPD.
Aside from the possible administration of medication to help combat perceptual and visual symptoms of HPPD, it is also recommended to:
- Stop usage of hallucinogenic and/or other illicit drugs.
- Reduce stress.
- Treat related conditions that could be worsening symptoms, such as anxiety or depression.
Most cases of hallucinogen persisting perception disorder resolve themselves after a few weeks or several months, but in rare cases, this condition can last for years or even become life-long.
Coping Mechanisms for Hallucinogen Persisting Perception Disorder
Apart from medication, there are several recommended methods of coping with hallucinogen persistent processing disorder and its symptoms. These can include:
- Stress Management.
- Finding Support Systems.
- Developing Healthy Habits.
- Creating and Sticking to Daily Routines.
Reducing stress levels is essential to minimizing the severity of the symptoms that may occur due to hallucinogen persisting perception disorder. Some simple and effective stress relief options may include:
- Practicing mindfulness
- Social interaction with loved ones
Seeking out guidance from a medical professional in learning how to cope with symptoms of Hallucinogen Persisting Perception Disorder may help individuals struggling with this condition in their daily lives. A therapist can help provide their patients with a number of coping mechanisms and skills, such as:
- Relaxation Techniques. Breathing exercises, desensitization skills, and grounding techniques to help combat possible depersonalization are all possible examples of tools a therapist may provide a patient experiencing HPPD.
- Cognitive Behavioral Therapy. This specialized form of therapy is geared toward teaching the patient to change their thoughts and perceptions of their situations and working towards developing more positive thinking habits.
- This therapy approach helps to reveal subconscious desires and needs and helps the patient to become more comfortable expressing and addressing these desires.
Finding Support Systems for Mental Disorders
Because hallucinogen persisting perception disorder is such a rare condition, those struggling with this (or any other persisting perception disorder) can feel extremely isolated. This makes finding and maintaining the right support system an important part of coping with this condition and its perceptual symptoms.
Aside from serving as a source of positive encouragement and empathy, supportive friends and family can also help to reinforce a sense of reality for individuals with symptoms of Hallucinogen Persisting Perception Disorder.
Those diagnosed with HPPD may also benefit from looking for support groups or communities with experience handling and living with a persisting perception disorder, as well as other disorders such as anxiety or depression.
Contacting our support team at Find Addiction Rehabs by simply calling us now can help connect you with the support system you or a loved one needs!
Developing Healthy Habits
For individuals struggling with HPPD, implementing healthy habits into their daily lives can be extremely beneficial when coping with their symptoms. Some of these habits may include:
- Eating healthy, balanced meals
- Maintaining regular mealtimes
- Exercising regularly
- Avoiding illicit drugs or substances, unless prescribed
- Avoiding caffeine or other stimulants may also be recommended
- Avoiding or limiting alcohol intake
Creating and Sticking to Daily Routines
While this may seem like a simple step, it is a very important one for people learning to cope with Hallucinogen Persisting Perception Disorder. Because flashbacks can be incredibly distracting and distressful in nature, having a routine implemented into an individual’s daily life can be incredibly grounding for those experiencing them. These routines can include:
- Waking up and going to bed at specific times during the day.
- Creating a schedule and developing time management/organization skills.
- Practicing basic self-care habits, such as brushing one’s teeth, showering, maintaining a clean and comfortable environment/living space, etc.
- Participating in hobbies and healthy social interactions.
Seeking Treatment for HPPD
For those struggling with hallucinogen persisting perception disorder, finding the right treatment option can be a difficult process. That’s why our team at Find Addiction Rehab is dedicated to offering effective tools and professional services to ensure quality assistance in finding the care and support you or a loved one needs.
Simply by contacting us using the form on our website, or by calling our 24/7 addiction hotline, you can find out which facilities and programs are best suited to helping those with HPPD on their road to recovery.
Receiving the care you need can be hard, but it doesn’t have to feel impossible; let us help you find the help you need. Call today to get started on a path to the world, and yourself, in a brighter and clearer way!
Nicole Rogers is an experienced and accomplished writer with special interests in the fields of Anthropology, English, and behavioral health, and has written countless articles for newspaper publications, institutional research journals, and Find Addiction Rehabs.
Her alma mater is Florida Atlantic University in Boca Raton. Nicole hopes to spread awareness of and combat the stigmatization surrounding addiction and substance abuse treatment through her writing and work in the field.